Adequacy of prenatal care considering nutritional assistance in Southern Brazil: Maternar Cohort Study

Abstract

We verified the prevalence of adequacy in prenatal care considering nutritional assistance and associated factors. It is a cross-sectional study, part of Maternar Cohort Study, conducted between 2018-2019 in Southern Brazil. Women were interviewed during hospitalization in the immediate postpartum period and data were collected from the prenatal chart. Prenatal adequacy and nutritional care were assessed according to criteria from the Brazilian Ministry of Health. Two outcome models were constructed. Outcome 1 consisted of minimal coverage (early prenatal start and minimum number of visits) and exams, and Outcome 2 comprised minimal coverage, exams, and nutritional assistance. Poisson regression was used to estimate prevalence ratios. A total of 802 women were analyzed, and we identified 57% of adequacy of Outcome 1. Unplanned pregnancy (PR = 0.76; 95%CI: 0.68-0.86), parity (PR = 0.88; 95%CI: 0.83-0.94) and prenatal care outside Porto Alegre, Rio Grande do Sul State (PR = 0.80; 95%CI: 0.69-0.92), were associated with lower prenatal adequacy frequencies. Outcome 2 was considered adequate for 10.2% of women. Follow-up by different professionals during prenatal care was associated with lower adequacy (PR = 0.49; 95%CI: 0.28-0.86). Women with high-risk pregnancies had a higher frequency of adequacy in Outcome 1 (PR = 1.21; 95%CI: 1.07-1.37) and in Outcome 2 (PR = 1.75; 95%CI: 1.16-2.64). General adequacy was considered low in both outcomes. There was a lack of nutritional assistance during prenatal care. Characteristics such as pregnancy planning, lower parity, prenatal care in Porto Alegre, follow-up by the same professional and high-risk pregnancy were predictors for the adequacy of prenatal care.

Development and Validation of a Protocol for Pregnant Women Based on the Brazilian Dietary Guidelines

“…Recent data on the diet of Brazilian pregnant women show a high consumption of ultraprocessed foods and a low-quality diet, evidenced by the low consumption of fruits and vegetables, especially in pregnant teens, mulatto and black women, and smokers. [9][10][11][12][13] The monitoring carried out by health professionals during prenatal care is a good opportunity to provide pregnant women with adequate advice on nutrition. However, dietary advice in prenatal care does not always occur, and when it does occur, it is carried out inappropriately or limited in content, not always consistent with current dietary guidelines, insufficient to meet the health needs of pregnant women, in addition to occurring from a vertical relationship between professional and user, perpetuating the care discontinuity, and nonadherence to dietary advice.…”

“…Recent data on the diet of Brazilian pregnant women show a high consumption of ultraprocessed foods and a low-quality diet, evidenced by the low consumption of fruits and vegetables, especially in pregnant teens, mulatto and black women, and smokers. 9 10 11 12 13 …”